Hair loss and hair fall are particularly distressing conditions where you feel that your once thick, beautiful mane is thinning day by day. Most people associate hair loss with menopause or old age but it can occur at any time in a person’s life- even during puberty! 

There are various types of hair loss and treatments for different causes. 

First, we need to understand the type of hair fall before deciding on treatment options. In the previous issue we learnt about different stages of haircycle. Every person has three types of hairs on their head – anagen (growing), catogent (resting) and telogen (shedding). 

Telogen effluvium occurs when there is a sudden increase in resting hairs over growing ones, leading to less body volume or ponytail size. This may sometimes lead to less hair volume at temple regions in females. 

How does TE get triggered? This condition may be triggered by nutritional deficiency, illness, major surgery or childbirth among many other stressful events which adversely impact the dermal papilla or hair root. 

What is the suggested treatment for TE? Your Dermatologist may prescribe Procapil, Capixyl or Biomimetic peptides, which increase the circulation around the hair root. They also enhance nutritional delivery to the hair follicle. One can use them for a longer period to see a visible improvement in Hair volume as well. Due to the slow hair cycle, it takes longer for hair to see a definite increase in volume especially in females.

Most importantly, one should be assured that telogen effluvium will not lead to baldness or permanent hair loss if treated well in time.

It is natural for men to experience hair loss as they age, but sometimes baldness can occur prematurely or more severely. Most often men notice the recession of that hairline near the temple area or thinning of hair near the vertex or crown of the head. 

What is Male pattern baldness or Androgenic Alopecia? 

We all understand that post puberty, men have increased levels of Dihydrotestosterone (DHT). DHT causes miniaturization of the hair follicle which leads to recession of hairline to some extent. Roughly when the recession reaches beyond an imaginary line between the two ears, we label it as Male pattern baldness or Androgenetic alopecia (AGA). 

Dermatologists use Hamilton Norwood Classification to grade the baldness and start you on treatment to avoid progression at Stage 3 and above. 

How do we control the progression of hair loss? There are two main approaches to control the progression – the first is to revert miniaturization and to reduce DHT activity. 

Minoxidil is one of the most commonly used FDA approved treatments. It is usually prescribed as a solution or foam in strengths of 2 %, 5% and even 10%. It is now available in oral tablet form as well. It works on potassium channels and enhances scalp circulation. It prevents further miniaturization to a certain extent. It is effective as long as it is applied. 

Regarding side effects, it may cause irritation, flakiness of the scalp and even allergic reactions in very few people. The allergic reaction is actually triggered by a preservative used in minoxidil preparations. It is approved as a 2% solution to be applied twice a day for women or 5% once a day. Men can use 5% twice a day and in few cases, even 10% is used. The oral tablet is being increasingly used by the Dermatologists but certain cardiac side effects are reported. 

One of the key challenges that I come across in my practice is the limited hair regrowth achieved by the topical solution, here in comes the role of hair regenerative medicine where increasingly we are trying to harvest the growth potential of the stem cells in the hair bulge region. Procedures like Platelet rich plasma (PRP) or Platelet rich Fibrin (PRF) help to achieve hair regrowth in certain patients. 

Other non-surgical treatment options –Microneedling and Mesotherapy where external hair growth factors are injected near the hair root to increase the hair diameter. 

Finasteride is used in oral and topical form to reduce the activity of 5 alpha reductase enzyme which converts Testosterone into Dihydrotestosterone. It may have potential side effects like erectile dysfunction, lack of libido or depression. Though in practice, we seldom see any side effects but one has to be investigated thoroughly before the treatment. Hair Transplant is a surgical option and I am keeping it outside the purview of today’s article and should be a separate discussion and write-up in a later issue.

Though treatment for hair loss remains the same, what makes the difference is the consistency of treatment, compliance with treatment and the impact of the overall healthy lifestyle. Dyslipidemia, smoking and nutritional deficiency may need to be worked up as well. 

Key to effective hairloss/hairfall treatment is that it should be initiated early to see better results. 

You can find her on twitter @divya_sharmaMD